Predictors for postoperative gastrointestinal complications in pediatric non-idiopathic scoliosis patients

Non-Idiopathic scoliosis (NIS) patients reportedly have higher postoperative complication rates compared to those with adolescent idiopathic scoliosis (AIS). However, there are limited data on the prevalence of gastrointestinal (GI) complications postoperatively, and the preoperative indicators that may predict them. This study aimed to determine the incidence and risk factors of postoperative gastrointestinal (PG) complications after neuromuscular/syndromic scoliosis corrective surgery.

163 NIS patients underwent spine deformity corrective procedure between 2005 and 2020. Radiographic, surgical, and clinical data were assessed. Patients were stratified based on postoperative GI complication status (PG vs. NPG) and ambulatory status (AMB vs. NAMB, based on GMFCS levels). Clavien-Dindo-Sink classification system was used to separate surgical complications based on severity. Wilcoxon-Rank Sum, Fisher's Exact, Chi-square, and McNemar's tests were utilized. Multivariable logistic regression was conducted. Matched analysis between NIS and AIS patients was conducted with 13 + levels fused.

There were 163 patients; 40 (24.5%) patients developed postoperative GI (PG) complications. The overwhelming majority of PG patients (39/40 patients, 97.5%) exhibited one or more minor complications with only 2/40 (5%) major complications; one patient had both 1 major and 1 minor. A greater portion of PG patients had pre-existing GI comorbidities (p < 0.001) and were non-ambulatory (p = 0.003). Non-ambulatory patients had more pre-existing GI comorbidities (< 0.001) and GI complications (p = 0.003) than ambulatory patients. Patients with pre-existing GI diseases had 5.34 times greater odds of developing a postoperative GI complication (p < 0.001), specifically those with a G-tube and followed by GI.

Non-ambulatory patients are more likely to exhibit GI complications. Pre-existing GI comorbidities, specifically G-tube and being actively followed by a GI specialist are high risk factors for postoperative GI complications.